Are hospitals producing quality care efficiently? An analysis using Dynamic Network Data Envelopment Analysis (DEA)

This paper examines efficiency of producing quality in hospitals between 2009 and 2013 using Dynamic Network Data Envelopment Analysis (DEA) and the hospital characteristics that contribute to this efficiency. Dynamic Network DEA was used to compute efficiency scores for hospital sub-divisions i.e. medical/surgical care (patient visits, surgeries and discharges) and quality. Pearson's correlation test was performed to assess if there are trade-offs or synergies between the efficiency of producing quality and efficiency of producing medical/surgical care. Multinomial logistic regression was performed to determine hospital and market characteristics that contribute to efficiency in production of quality outputs. Efficiency of quality production improved significantly between 2009 and 2013 with no trade-off between efficiency of producing quality outputs and efficiency of producing medical care. Urban and teaching hospitals were less likely to improve efficiency of quality production.

[1]  Gary D. Ferrier,et al.  Rural hospital performance and its correlates , 1996 .

[2]  Gary D. Ferrier,et al.  Incorporating quality into the measurement of hospital efficiency: a double DEA approach , 2013 .

[3]  Ann Barry Flood,et al.  Commentary: Slack resources in health care organizations--fat to be trimmed or muscle to be exercised? , 2009, Health services research.

[4]  S. Rhoades.  The Herfindahl-Hirschman index , 1993 .

[5]  J S Zinn,et al.  The impact of market and organizational characteristics on nursing care facility service innovation: a resource dependency perspective. , 1996, Health services research.

[6]  W. Cooper,et al.  Data Envelopment Analysis: A Comprehensive Text with Models, Applications, References and DEA-Solver Software , 1999 .

[7]  Jay S. Kaufman,et al.  Defining Urban and Rural Areas in U.S. Epidemiologic Studies , 2006, Journal of Urban Health.

[8]  E R Becker,et al.  Determinants of hospital casemix complexity. , 1981, Health services research.

[9]  J S Zinn,et al.  Resource dependence and institutional elements in nursing home TQM adoption. , 1998, Health services research.

[10]  A. Mehrotra,et al.  The Association Between Health Care Quality and Cost , 2013, Annals of Internal Medicine.

[11]  Yihua Xu,et al.  A longitudinal examination of hospital registered nurse staffing and quality of care. , 2004, Health services research.

[12]  N. McKay,et al.  Cost inefficiency and mortality rates in Florida hospitals. , 2006, Health economics.

[13]  Joseph Sarkis,et al.  Preparing Your Data for DEA , 2007 .

[14]  W. Scott,et al.  Organizations and Organizing: Rational, Natural and Open Systems Perspectives , 2006 .

[15]  Eric Rollins,et al.  Data Shows Reduction in Medicare Hospital Readmission Rates During 2012 , 2013 .

[16]  Ming-Miin Yu,et al.  An Application of the Dynamic Network DEA Model: The Case of Banks in Taiwan , 2015 .

[17]  T. Mackey,et al.  Quality and safety in medical care: what does the future hold? , 2011, Archives of pathology & laboratory medicine.

[18]  Hirofumi Fukuyama,et al.  A dynamic network DEA model with an application to Japanese Shinkin banks , 2013 .

[19]  V. Valdmanis.  Ownership and technical efficiency of hospitals. , 1990, Medical care.

[20]  Yasar A. Ozcan,et al.  Health Care Benchmarking and Performance Evaluation: An Assessment Using Data Envelopment Analysis (DEA) , 2007 .

[21]  G. Dong.  Performing well in financial management and quality of care: evidence from hospital process measures for treatment of cardiovascular disease , 2015, BMC Health Services Research.

[22]  Yasar A. Ozcan,et al.  Assessing efficiency of public health and medical care provision in OECD countries after a decade of reform , 2017, Central Eur. J. Oper. Res..

[23]  M. Rosko,et al.  Measuring hospital inefficiency: the effects of controlling for quality and patient burden of illness. , 2008, Health Services Research.

[24]  Joe Zhu,et al.  Data envelopment analysis: Prior to choosing a model , 2014 .

[25]  Gerald A Klopp,et al.  THE ANALYSIS OF THE EFFICIENCY OF PRODUCTIVE SYSTEMS WITH MULTIPLE INPUTS AND OUTPUTS. , 1985 .

[26]  K. Carey.  Hospital Cost Efficiency and System Membership , 2003, Inquiry : a journal of medical care organization, provision and financing.

[27]  V. Valdmanis,et al.  Hospital quality, efficiency, and input slack differentials. , 2008, Health services research.

[28]  Deepak L. Bhatt,et al.  Regional Variation in the Incidence and Outcomes of In-Hospital Cardiac Arrest in the United States , 2015, Circulation.

[29]  Kaoru Tone,et al.  Dynamic DEA with network structure: A slacks-based measure approach , 2013 .

[30]  R. Färe,et al.  Productivity Growth, Technical Progress, and Efficiency Change in Industrialized Countries , 1994 .

[31]  Audrey J Weiss,et al.  Overview of Hospital Stays in the United States, 2012 , 2012 .

[32]  Robert N. Stern,et al.  The External Control of Organizations: A Resource Dependence Perspective. , 1979 .

[33]  J F Burgess,et al.  On measuring the hospital cost/quality trade-off. , 1999, Health economics.

[34]  H S Luft,et al.  Effects of Surgeon Volume and Hospital Volume on Quality of Care in Hospitals , 1987, Medical care.

[35]  Yasar A. Ozcan,et al.  Data Envelopment Analysis Comparison of Hospital Efficiency and Quality , 2008, Journal of Medical Systems.

[36]  T. Wan,et al.  Modeling organizational determinants of hospital mortality. , 1991, Health services research.

[37]  Sarah Miller,et al.  Early Coverage, Access, Utilization, and Health Effects Associated With the Affordable Care Act Medicaid Expansions , 2016, Annals of Internal Medicine.

[38]  Matthew S. Kraatz,et al.  How Organizational Resources Affect Strategic Change and Performance in Turbulent Environments , 2001 .

[39]  G. Pope.  Occupational adjustment of the prospective payment system wage index , 1989, Health care financing review.

[40]  Kaoru Tone,et al.  Network DEA: A slacks-based measure approach , 2009, Eur. J. Oper. Res..

[41]  D. Blumenthal,et al.  The Affordable Care Act at 5 Years. , 2015, The New England journal of medicine.

[42]  F. Sloan,et al.  Utilization of hospital services: the roles of teaching, case mix, and reimbursement. , 1983, Inquiry : a journal of medical care organization, provision and financing.

[43]  Cheryl B. Jones,et al.  An Examination of Technical Efficiency, Quality, and Patient Safety in Acute Care Nursing Units , 2009, Policy, politics & nursing practice.

[44]  Necmi K. Avkiran,et al.  An illustration of dynamic network DEA in commercial banking including robustness tests , 2015 .

[45]  Gabriel Picone,et al.  Hospital Ownership and Cost and Quality of Care: is There a Dime&Apos;S Worth of Difference? , 1998, Journal of health economics.

[46]  Kaoru Tone,et al.  Estimation of the efficiency of Japanese hospitals using a dynamic and network data envelopment analysis model , 2014, Health care management science.

[47]  Vivian Valdmanis,et al.  High versus lower quality hospitals: a comparison of environmental characteristics and technical efficiency , 2010, Health Services and Outcomes Research Methodology.